The patient was taken to the operating room where spinal anesthesia was administered without difficulty. The patient was prepped and draped in the usual sterile fashion in the dorsal supine position with a leftward tilt. A Pfannenstiel skin incision was made with the scalpel and carried through to the underlying layer of fascia using the knife. The fascia was incised in the midline and extended laterally using Mayo scissors. Kocher clamps were used to elevate the superior aspect of the fascial incision, which was elevated, and the underlying rectus muscles were dissected off bluntly and using Mayo scissors. Attention was then turned to the inferior aspect of the fascial incision, which in similar fashion was grasped with Kocher clamps, elevated, and the underlying rectus muscles were dissected off bluntly and using Mayo scissors. The rectus muscles were dissected in the midline.

The peritoneum was identified and entered bluntly; this incision was extended superiorly and laterally with good visualization of the bladder. The bladder blade was inserted. The vesicouterine peritoneum was identified and entered sharply using Metzenbaum scissors. This incision was extended laterally and the bladder flap was created digitally. The bladder blade was reinserted. The lower uterine segment was incised in a transverse fashion using the scalpel and extended using manual traction and bandage scissors.

Clear fluid was noted. The infant was subsequently delivered through the hysterotomy without difficulty. The nose and mouth were bulb suctioned and the cord was clamped and cut. The infant was subsequently handed to the awaiting NICU team. The placenta was delivered spontaneously intact with a three-vessel cord noted. The uterus was exteriorized and cleared of all clots and debris. The uterine incision was repaired in 2 layers using 0 vicryl sutures. Hemostasis was visualized.  The uterus was returned to the abdomen. The uterine incision was reexamined and it was noted to be hemostatic. The gutters were cleared of all clots. The rectus muscles were inspected and noted to be hemostatic. The fascia was closed with two 0 Vicryl sutures from each incision angle, the subcutaneous layer was closed with 3-0 vicryl, and the skin was closed with 3-0 Monocryl. Sponge, lap, and instrument counts were correct x3. The patient was stable at the completion of the procedure and was subsequently transferred to the recovery room in stable condition.